診断に難渋した足関節踵腓靱帯損傷の1例

Elongated Calcaneofibular Ligament and Ankle Locking. Case Report

　軽微な外傷をきっかけに，足関節外側部痛を伴うロッキング症状を呈し，術前には診断ができなかった症例を経験した．患者は，正座から立ち上がったときに足関節外側部痛を生じ，足関節が動かせなくなることがあった．術前検査として足関節造影検査が有効で，踵腓靱帯損傷が疑われた．術中所見において，踵腓靱帯が距腓関節に嵌頓しており，伸長し細くなった靱帯を関節内から引っ張り出すことができた．この靱帯を縫縮することにより，術後9カ月の現在，ロッキング症状と疼痛が消失し，正座も可能となった．

　This is a report of the case of a patient who complained of lateral ankle pain and ankle locking after a minor bruise.　No ankle instability or peroneal tendon dislocation was detected during the physical examination, and no osteochondral lesions were identified on computed tomography scans.　A calcaneofibular ligament injury was suspected based on the arthrography findings.　At surgery the peroneal tendon sheath was found to be slightly redundant, and fluid had collected in it.　The elongated calcaneofibular ligament was placed in the talofibular joint but slipped out of it easily.　It was shortened by suturing and tethered to its insertion with an anchor suture.　The superior peroneal retinaculum was repaired and made tauter.　A good result was achieved with a smooth gait, no ankle locking, and a full range of motion of the ankle.